Dengue, or break-bone fever : as it appeared in Savannah in the summer and fall of 1850

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DENGUE, OR BREAK-BONE FEYER,

AS IT APPEARED

IN SAVANNAH

SUMMER AND FALL OF 1850

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By R. D. ARNOLD, M. D., .

PROF. THEORY AND PRACTICE OF MEDICINE IN SAVANNAH MEDICAL

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1858.

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1858.] Arnold : Dengue, or Break-bone Fever.

ARTICLE XXI.

Dengue, or Break-bone Fever, as it appeared in Savannah in the
Summer and Fall of 1850. By R. D. Arnold, M. D., Prof.
Theory and Practice of Medicine in Savannah Medical College,
Savannah, Ga.

[By the request of several of my fellow practitioners, 1
republish from the Charleston Medical Journal of May, ISM,
the following article on Dengue or Break-bone. The epi-
demic through which we are now passing has been, at least
to myself, instructive and suggestive as to the true history
and nature of some of our epidemic diseases. I would not
venture to speak authoritatively for others, unless I did it by
the card, but I certainly may venture to assert that many
medical men of our city with whom I have conversed, do not
differ from me very widely. I allude especially to those
who witnessed the epidemics of 1850 and 1854. For my sell,
my belief has been fixed to one point, since the yellow fever
epidemic of 1854; and the epidemic of the present season,
has merely accumulated proof to my mind, not furnished
any neiv proof; and that point is the identity of Dengue
or Break-bone with Yellow Fever. A perusal of the sub-
joined article will show that this belief has been approxima-
ted before in our own city, but that the belief stopped with
" similarity." At a future time I shall endeavor to give
proof of this. Our present epidemic I consider to be one
of the Dengue alias Break-Bone type of Yellow Fever,
(which I believe to be the mild form of Yellow Fever) as
regards the vast majority of cases, but cropping out through
and among these, and not distinguishable in the first stage,
as noticed by Dr. Waring, we have had the genuine malig-
nant Yellow Fever. This I have verified this year, both at
the bedside and on the dead body.

The small mortality compared with the large number of
sick persons has led, if I have been informed correctly, some
of our lay citizens to doubt whether we have really had any
Yellow Fever at all among us.
vol. i. — 30.

'.'/,.•

'I Arnold: Dengue, or Break-bone Fever. .[Nov

Whatever may have been the real cause, our citizens have
reason to be thankful that the visitation of the pestilence has
been so mild, and in such distinguished contrast to the se-
verity which has afflicted neighboring cities. "Our physi-
cians," .said a gentlemen to me recently, "have, perhaps,
learned how to treat the disease better than heretofore."
"Pardon me," was my reply, "let no one use such self-decep-
tion, the mortality hai been less, because Ihe virulence of
the poison lias been /ess, producing only the mild type of
the Break-bone, in the. generality of coses."

This is my conviction on the subject. At ryesent I have
no time to say anything more on it. 1 republish the
article entire, because, in 1850, many referred the origin
of the Break-bone to contagion from Charleston. This year
many are of the same opinion as to our epidemic, believing
that the steamer Catawba brought it thence hither. Others
seem as firm in their belief thai the comet has some myste-
rious influence in the matter. I shall not attempt to decide.

Savannah, Oct. 14, 1858. R. D. Arnold, M. D.]

fFrom the Charleston Medical Journal lor May. I85L]

The winter of 1849-'50 exhibited to the practitioners of our city,
;is mi epidemic, a disease which they had met beforeonlj in isolated
cases; I allude to erysipelas, which, commencing late in the fall of
lS4«.t. prevailed during the whole winter, and until the end of May.
to such an extent as fairly to entitle it to be considered an epidemic.
I mention this tact, not to give an\ history of it, but to show that,
taken in connection with the general spread and long continuance of
nieascls in L847 and 1848. the existence to a, considerable degree of
scarlatina in L849, and the subsequent appearance of the dengue in
1850. there has been for the last few years what ma\ he termed a
decidedly epidemic exanthematous constitution of the atmosphere.

I use the phrase constitution of the atmosphere, for want of a
Letter or more definitive one ; for, with all the resources of modern
art. the ultimate cause of epidemic diseases has eluded research, and
wo are obliged to go into the domain of conjecture. The < < 1 1 1 \ ap-
preciable modifier of disease is the temperature of the atmosphere,
as we know changes in it are often the exciting causes of catarrha, rheu-

1858.] Arnold : Dengue, or Break-bone Fever. 3

matism, etc.; and temperature is itself modified by locality and

latitude. In a few words, although a well digested meteorological
table nia\ record all the variations of temperature, it cannot at am
tunc afford a solution as to the ultimate cause of epidemics.

After all our inquiries and conjectures, we arc compelled to con-
tent ourselves with repeating the old adage. "Latet causa, vis est
notissima."

During the spring of 1850, a few eases of scarlatina occurred in
my practice; but although they were very severe ones, I could not
say that they were numerous enough to justify me in stating that
this disease was epidemic.

I was absenl from the city during the month of May. June was
remarkable for its pleasant temperature. Refreshing showers fell,
and, although, as a general rule, this month is hot and dry, it was
not so as in L850. There was very little sickness of any kind
during this; month, except a few cases of bowel affections. July, on
the contrary, was intensely hot and very dry. The pleasant weather
of June, spoiled us for the heat of July, and rx^vy body seemed
really to suffer from the oppressive heal. As a general rule, when
the weather is dry as well as hot in the early summer months, there
is very little sickness among us. Last July was no exception to
this rule. About the end of July, the report reached us that the
break-bone, or dengue lexer, was prevailing very extensively in
Charleston.

About the beginning of August, our endemic climate lever began
to appear, as customary. This lever is always periodical in its
character. At least, in the course of twenty years practice, I have
never met it in any other form than that of intermittent or remit-
tent, in their various modifications. A daily communication is kept
up between Charleston ahd Savannah by steam-boats, and there Mas
>'\i-r\ oppoatunity afforded for a direct importation of the disease.
if it preferred that mode of coming among us.

The fact is. that the break-bone, or dengue. fever, was no stranger.
although a good many years had elapsed since it had made a regu-
lar sojourn among us.

As brief a reference to its past history in this city as perspicuity
will permit, may be interesting in more than one point of view, and
1 am the more inclined to make it. because, with all deference to so
high an authority as l)v. Dickson. I think he has somewhat misap-
prehended the views entertained of this disease by my esteemed
preceptor, the late Dr. Win, R. Waring, of this city.

Arnold : Dengue, or Break-bone Eever. [Nov.

In Dr. Dickson's new classic essay upon dengue, published in Dr.
Bell's Select Medical Library in 1839, speaking of Dr. Waring, ha
Nivs, that Dr. W. "makes his break-bone fever of 1826, identical
with the autumnal fever of 1827, whieh, again, he looks upon as
identical with yellow fever ; thus mingling in promiscuous confu-
sion, yellow fever, ordinary billious remtitent, break-bone and den
gue." (p. 12.)

In the April number of the North American Med. and Surgical
Journal of 1830, Dr. Waring published an article on "the epidem-
ics at Savannah, in the beginning of which we find the following
sentences; which, by leaving out the words " novel and unknown
here," might well be taken for a general description of the epidemic
o' last summer.

"We commence our account with the fall of 1826, which was dry
vi id warm. It produced a species of disease novel and unknown
li. re, which the people designated by the significant denomination
of break-bone fever. Its distinctive features consisted of violent pain
of the head and loins, with a sort of rending of the bones of the ex-
tremities, of a. single paroxysm of various duration, and a temporary
inflammation of the skin and eyes. Scarcely any person escaped, of
of whatever color, age, sex, constitution, occupation or habits ; and
yet, notwithstanding this extensive prevalence, no instance of death
occurred, at least of which I have been informed. The first cases
excited great alarm ; the fury of the symptoms, and early illness
into which the patient seemed to be precipitated, presented the as-
pect of a disease uncontrollable and speedily destructive. A little
experience, however, discovered, that the pain and suffering very far
surpassed the degree of peril, and that instead of being, as it threat-
ened to be, an affection beyond remedy, it really required scarcely
any remedy at all. It was an ephemeral gust, which did not destroy
but prostrated the muscles and the digestive function, and left be-
hind it as great a sense of general debility as results from a tedious
attack of autumnal fever."

A little further on, speaking of the diseases of the months of
July, August, September, and October, IS 7, he says:

"These latter portions of the year gi e rise not merely at dif-
ferent times, but also at simultaneous pe- >ds, to some very extra-
ordinary varieties in the prevalent fever. , erhaps two-thirds might
have been distinct intermittents, while am tier third was composed
of remittents nearly intermittent, of yell >w fever in its worst de-
gree, and of genuine eruptive break-bone."'

1858. J Arnold: Dengue, or Break-bone Fever.

The distinction is here kept up most clearly, and the epithet erup-
tive applied to break -bone is particularly significant. He further says-.

"Cases of black vomit and break-bone were so minutely similar
in the first, stage, that you could not identify them."

This is not extraordinary to any one familiar with the excrucia-
ting pains in the lumber region and the lower extremities, which so
often usher in attacks of autumnal fever, or indeed any severe feb-
rile affection. Nay, this has induced some physicians in the South-
ern country to look to the spinal column as the seat of the morbid
derangement in our climate fevers.

It may illustrate this point, to state that in relation to these pre-
liminary pains, I have twice made a mistake in my person, each
time being wrong as to the disease. In 1828, while a pupil with
Dr. Waring, and when, as I shpll detail hereafter, the dengue was
prevailing epidemically in Savannah, I was seized with some fever
and such excruciating pains in my loins and lower extremities, that
I was certain that I had the dengue. I was mistaken. This was
but the ushering in of a severe bilious fever, which nearly cost me
my life. The events of that sickness are too firmly impressed on
my memory for me ever to forget them.

As to my second mistake, I quote from my article on the epi-
demics of Savannah, published in the Charleston Journal for July.
1 849, when giving an account of the attack of dengue, from which I
suffered in the fall of 1848. When describing the commencement
nS the attack. I said :

"l felt an uneasy sensation down my thighs and legs, and a singu-
lar weakness in my knees. These symptoms increased so much on
me, with the addition of a violent pain in the small of my back,
that I hurried through my business and returned home, apprehend-
ing that I had the premonitory pains of a malarial fever,"

Here was an error again, they were the preliminary pains of
dengue.

Again Dr. Waring says, in relation to the year 1828:

•'About the last of August, north east winds resumed their usual
predominance, and another eruptive epidemic was ushered in. It
differed so slightly from the break-bone of 1826 and 1827, that in
my notes I find the first cases called by that name, according to
popular usage. This distinctive appellation, however, was soon
supplanted by the Spanish word dengue, which had migrated from
Havana to St. Mary's, Savannah and Charleston. The best explan-
atory denomination for common parlance, would have been eruptive

Arnold : Dengue, or Break-bone Fever. [Nov.

rheumatism, or rheumatic eruptions, because it expresses the prom-
inent form and features."

The last sentence is certainty as applicable to the epidemic of
(850, in our eity,as it was to that of 1828. The next extract which
[ shall make from Dr. Waring's paper, points out what differences
existed between the epidemic of 182(5 and that of 1828.

"I have said that dengue was essentially the break-bone, which we
had experienced in 1820, and also in 1827, The analog} was so
striking, that I do not believe we would have called it by another
name, if it had not appeared in some other Southern cities at the
same time."

I beg to call attention to this testimony, (published in 1880, but
really written in 1829.) as to the identity of the two epidemics,
then so recent.

To any practitioner who has seen cases of our recent epidemic, I
think these quotations will prove that Dr. Waring had noticed the
peculiarities of dengue with a careful and critical eye. It will be
observed that he calls it "a disease novel and unknown here." lie
then details the symptoms distinctive of the disease, and points out
wherein it differs from other diseases.

As to the pathology of the disease, Dr. Waring was clearly mis-
led by his devotion to the Broussaian theory, which was then revo-
lutionizing the medical world. Every disease was a. gastro-enteritis,
in some shape or other. Dr. W. was strong in his belief that this
disease was a gastro-enteritis. Now, that term in those days was
applied to every disease in which the stomach was involved, never
mind in what manner This belief gave dengue, in his view, some
resemblance to other diseases besides yellow fever. After detailing
a case, he says :

"The pathologv of dengue thus exhibited, assimilates curiously to
three different diseases of gastro-enteritic foundation, viz: gout, ery-
sipelas and yellow fever."

Now it can hardly be thought that this is meant for more than to
designate some points of assimilation. This assimilation is pointed
out to uphold a theory, and it in no manner means to make this dis-
ease, as identical with gout, erysipelas, or yellow fever. More to
show that this gastro-enteritic ground was merely theoretical, he
says expressly :

"As no case of regular dengue terminated mortally, it is not in
my power to furnish any example of the morbid anatomy of its

1858. J Arnold: Dengue, or Break-bone Fever.

simple state, and to demonstrate, through this corroborating means,
its gastro-enteritic character. 11

The resemblance to yellow fever is confined by him expressly to
the first stages of the disease. Now, is it not always a difficult
task to distinguish the particular nature of a fever in its very first
stage ! A iv there not certain preliminary symptoms common to all
fevers, indicating the general febrile disturbance of the system, but
by no means what peculiar cause is producing that disturbance?

Here then, 1 rest nay retrospect of the history of dengue, so far as
this city is concerned, with the exception of its partial prevalence in
1848, as detailed in ray article in the July number of the Charleston
Journal, for 1849.

On the morning of the 29th of August, 1850 1 was summoned in
baste to see Mr. T. M., a resident of this city. 1 found on my ar-
rival that hi" had passed a restless and painful night, and that he was
then suffering acute pain in the lumbar region, in the lower extremi-
ties, and in the. head, from one temple to the other. The skin was
hot and dry ; the tongue coated with a thick white fur; the pulse
accelerated and rather full. The reader will see in this description
nothing more than what be has observed, in many instances, of the
ushering in of an ordinary climate t'exw. I prescribed a purgative of
salts, senna and manna. On my visit in the afternoon, the fever
was as high as ever, and there was no abatement in the severity of
the pain. The medicine had not acted freely, and as the head was
much complained of, I directed a purging enema and a warm foot bath.

On my visit on the 30th, the problem was solved, I discovered
an eruption over the face and trunk of red points, not minute like
the flea bite point of measles, nor in that crescentic form, which the
aggregation of these points produces in that disease, but more re-
sembling the eruption of scarlatina, in its interrupted form. The
eruption was also attended with a tingling or itching sensation. 1
pronounced it at once to be the dengue, or break-bone fever.

In the same row of buildings, a. few doors off, the same train of
events had simultaneously taken place with a child of about seven
years of age.

Now I confess that, although from the fact that the dengue was
prevailing epidemically in Charleston, 1 had every reason to suppose
that Savannah would not escape the epidemic influence ; and that,
therefore. 1 had been watching tor some case of this disease, I did not
suspect either of these two cases to be dengue until the eruption
made it palpable.

3B Arnold : Dengue, or Break-bone Fever. [Nov.

The symptoms -were bo analogous to those presented in 1848, two
years antecedently, that there was no difficulty in settling positive!/
the character of these two cases.

No new cases occurred to me until the 4th of September. After
this, the disease assumed an epidemic character, find spread in vari-
ous parts of the city. As the chief point of interest in a descrip-
tion of this disease, is to settle its precise nosological character, I
shall confine myself to a summary of the prominent, symptoms de-
veloped in its appearance here.

The pains felt in all parts of the body, on the commencement of
this disease, were very severe. In this epidemic, the pains were de-
cidedly more muscular than arthritic. The muscles of the back
were very much affected, as also those of the lower extremities.
But there was universal soreness in all the muscles, rendering any
change of position painful in the extreme. In infants, I very fre-
quently diagnosticated true dengue, from the evident pain produced
by any motion of the body, or by simple handling.

It is easy to account for the name of this disease, as far as break-
bone is concerned, for in case alter case, have I heard the exclama-
tion from the lips of the patient, "oh, my bones are broken."
Sometimes the pain was more predominant in one particular part of
the body than in another. One gentleman declared to me that he
felt that he must die, if I did not do something to relieve the op-
pression across his chest. Another complained of a sensation across
his thighs, as if a heavy rail had beeen laid over the middle of
them.

In the majority of cases there was a severe headache, shooting
from temple to temple ; an injection and watering of the eyes,
•and an intolerance of light, and acute and intense pain in moving
the eye-balls. This was evidently owing to the aflection of the
sclerotic coat, Most generally the tongue was furred white, and
there was a craving for cold drinks.

The pulse did not exhibit the disturbance that would be expected
from the severity of the other symptoms. It was but seldom accel-
erated beyond one hundred ; generally, it was but little over a hun-
dred. I do not recollect of ever having met with it as high as one
"hundred and twenty. These preliminary symptoms were of longer
duration in some than in others. They were followed, at various
intervals of time, by an eruption, which, taken in connection with
the anterior febrile disturbance, I consider as distinctive of the dis-
ease. I did commence to keep notes of the time at which the

1858.] Arnold : Dengue, or Break-bone Fever.

eruption appeared, after the first febrile symptoms, but the eases
differed so materially in this particular, that I found it impossible to
ascertain any definite rule. Sometimes, on my first visit, I found an
eruption developed. Then, again, it would become apparent the
second day, or the third. When the eruption was tardy, it was
very puzzling to know whether you were about to have a climate
fever, or the dengue. The coats of the stomach were evidently
more affected in these cases than in the others.

The skin was certainly the outlet of the system, by which the
morbific matter of this disease was to escape, and hence, when any
obstacle occurred to this, the internal organs were more disposed to
suffer. The quicker the eruption made its appearance, the shorter
was the sickness. The pains subsided very shortly after the ap-
pearance of the eruption, but the sense of debility left behind was
really astonishing. Prior to the eruption, the fever was always
continuous, never mind what time elapsed between it and the first
seizing of the disease. In most cases, there was no return of
the disease. The digestive functions were very much weak-
ened, and, in some, there was an irritability of stomach which
was very troublesome. In general, I should say that there was
very pure debility of the stomach after the acute stage of the dis-
ease ; for, contrary to Dr. Waring's experience, I found that during
convalescence, so far from producing any uneasiness, it was impossible
to coax the stomach into digestion without the aid of some stimulus,
either a vegetable tonic, a little weak brandy and water, or porter.

Those cases which were followed by irritability of the stomach,
did not, however, bear this treatment. There was in these an evi-
dent derangement in the mucous coats of the stomach, and a disturb-
ance in the functions of the liver. The tongue would show a bilious
fur, and a mercurial purgative would prove the most efficient means
i >f restoring the digestive organs to their healthy tone. It was not
until after this had been done that you could venture on the tonic
and stimulant method.

Now, in this secondary affection of the stomach and liver, I see
nothing more than a complication arising from the general predispo-
sition to gastric disease, which always exists in warm climates,
during the summer and fall months. It was not distinctive of the
disease, as it existed in only a small portion of those affected. But
the eruption was distinctive, and I never considered a case one of
true dengue, unless this made its appearance. Another distinctive
feature of this disease was, that the pains were evidently neuralgic

VOL. I. 31.

10 AnNOLD: Dengue, or Break-bone Fever. [Nov.

in their character, for even when they lasted twenty-four, and thirty-
six, and forty-eight hours, they did not produce that disturbance of
l he general circulation which they would have done had they been of
iui inflammatory nature.

Now. when reference has been made to the difficult) of deciding
between an attack of dengue, and one of climate fever, it must be
recollected that, in common with Dr. Waring. I confine it to the
first stage of the dengue. Remission or intermission would, un-
doubtedly, take place in climate fever, in the course of twenty-four
hours. But the paroxysm of fever ushering in dengue was a con-
tinuous one, even if it lasted forty-eight hours.

That after the distinctive eruption has appeared, the patient haa
suffered intermittent or remittent fever, does not affect the question,
lor an attack of the dengue afforded no exemption from an attack of
climate fever. I treated many patients, during last season, who had
first had dengue, and after an interval of two or three, or four
weeks, suffered from climate fever, and vice versa. If, then, we
have a disease, which, as a ride so very general, as to admit of fe\*
exceptions, (and to which I myself know of none.) is ushered in by
severe muscular and arthritic [tains, one, or both, and by a contin-
uous paroxysm of fever, and ending in a cutaneous eruption, win
should it be even assimilated to climate fever 1 hi manv eases
under my treatment, the patient alter the eruption has improved so
much that I have ceased to attend, thinking him quite well; but the
next day I would lie summoned back, and find my patient quite
sick, with fc\{-v and gastric disturbance. I always considered and
treated these cases as complications of climate fever, because they
always gave more or less evidence of gastric and biliary derange-
ment, and invariably assumed a remittent or an intermittent form-

During the whole existence of this epidemic amongst us, we had
our usual endemic fill fever, assuming as common, either an inter-
mittent or remittent type. I have attended cases of each lying
alongside of each other, among children of one. family, and also
among the poorer classes of whites, (foreigners) who huddle together
in an extraordinary manner; and yet each has run its course unmod-
ified by the presence of the contiguous disease.

The eruption, as tar as I saw it. was only of two kinds, one in
patches, the other diffused. Roth were smooth, until the cuticle
began to dry and desquamate. Some few cases of eruption were
as red and diffused as I ever saw in true scarlatina, in all, the
eruption could be prewsed back by the fingers, leaving a white mark.

185h.| Arnold: Dengue, or Break-bone Fever. 11

until the blood rushed back into the capillaries. By this mode, I
convinced very many persons, (white of course) that they had an
eruption ; for. in some instances, the blush of the skin was very
taint, but pressure would prove by the superior whiteness left under
the finger, that there was an injection of the vessels of the periphery.
This also proves that the cutaneous inflammation i* seated in the
outer or cuticular surface of the cutis vera.

The duration of the eruption, and the absence of any anginose
affection, as well as the violence of the preliminary symptoms, dis-
tinguish it from scarlet fever. The eruption in dengue was the sign
for the abatement of the symptoms. So far from this being the
case in scarlatina, we know that generally the worst symptoms are
developed after the eruption has appealed.

In scarlatina, the skin never breaks out into a perspiration on the
first appearance of the eruption. In dengue, after the eruption has
been well thrown out, the fever goes off by moisture, on the skin.
The eruption lasts but two or three days in dengue; in scarlatina,
it lasts six or sev«n. hence there is decidedly more desquamation of
the cuticle in the latter than the former. The tongue also affords a
guide. In the commencement of the eruptive stage of scarlet fever,
the mucous membrane of the mouth participates in the efflorescence.
and as the external skin begins to throw off its cuticle, the cuticle
of the tongue is also thrown off, and the tongue appears bright, red
and shining : and the papillae, being deprived of their cuticular
sheath, becomes very prominent on its surface. When scarlatina
prevails epidemically, it is by the tongue that 1 diagnosticate this
disease among our blacks. Whatever redness of the lips, tongue
and gums may take place in dengue, it is not, as tar as any case lias
come under my observation, ever likely to be mistaken tor the red-
ness of scarlatina, for it is less intense in color, lasts a muc^ shorter
time, and is not followed by that throwing off of the cuticle of the
tongue, which is so apparent in this last disease. l.o two cases oc-
curring in children. I saw general oedema follow the desquamation
of the cuticle, exactly : s it does in scarlatina. They were both
very fair, thin skinned children, and I suppose the skin was in them
than usually sen-' :ive.
The heat of the we: ! ter produced at: unusual quantity of prickly
heat, (lichen propicur.) Any one who has seen the two eruptions
would not readily conf* r.nd them, if he should examine with any
care. Prickly heat i t: : distinct papular disease, that is to say con-
sists of hard and solid levations. 1 was very inaccurate in my ar-

12 Arnold : Dengue, or Break-bone Fever. [Nov.

tide of July, 1849, when 1 spoke of the eruption as being papular
in those cases occurring in the fall of 1848, and I must have decided
too hastily, for now I plainly see the difference between a real papu-
lar disease and the eruption of dengue. 1 meant to express the fact,
that the eruption occurred in points or patches, as in measles, and
not in the uniform diffuse redness of scarlatina, But this was not
the case during the last summer, for many of the cases presented a
uniform, scarlet-red diffused eruption. There was also an uncom-
mon quantity of boils last summer, among grown persons as well
as children. Indeed, I think I might safely say that they were en- (
titled to be considered epidemic also.

My treatment of this disease was very simple. 1 purged with
epsom salts, either plain or in infusion of serpentaria; directed sin-
apisms when the pains were very intense and hot foot-baths; some-
times I gave antimonials as sudorifics, never as emetics; to allay
thirst and produce perspiration, I ordered hot lemonade ; after the
bowels had been moved, I used opiates \ery freely, and with most
decided alleviation of the painful symptoms ; where there was no
irritability of stomach, I preferred Dover's powder to any other.
I am catisfied that not one quarter of the cases that occurred were
treated by physicians. The disease was very general, and 1 be-
lieve that very few in the whole city escaped it. This is satisfactory
proof, that this epidemic was as harmless in its results upon life as
its predecessors have been. I know of no instance of a death having
occurred from simple. uncomplicated dengue. But the suffering, in
many caseO, was very great, and I am satisfied that it was very
greatly alleviated by remedies. Moreover, it was much to be
aware that the violence of the symptoms was no evidence of the
danger of the disease, and hence we were enabled to avoid heroic
depleting remedies, and to preserve for the patient as much strength
as possible, fur what always proved a tedious convalescence. In-
deed, I must consider the extraordinary debility left after an attack
of this disease, (it being so comparatively short in its duration,) and
the slow and tedious convalescence as peculiarly characteristic of it.

And now the que tion occurs, what ia dengue 1 I have no doubt
it ought to be classed as a specific exanthematous fever. The vari-
ations observed in ' in its enidemic existence at different times, are
n greater thai; those which occur in scarlatina or rubeola, at various
t^.Ties of their prevailing. Its variation, as it occurred here in 1828
a 1 " : in 1850, consisted in the fact, that in the former year it was
more "vthritic. Dr. Waring, in the article cited above, speaks of

1858.] Arnold: Dengue, or Break-bone Fever. 13

the alleviation of the pain, "after a bright red eruption had made its
appearance." He also asserts that "the eruption was developed in
most cases;" and that in "some cases it spread in patches; in others,
in an unbroken flush, over a greater or less extent."

Here then is a disease presenting peculiar symptoms, viz : a feb-
rile disturbance, and violent pains in the limbs or joints, or both,
preceding an eruption of a bright red color, at intervals of time
somewhat varying, but seldom exceeding forty-eight hours; this
eruption of a determinate duration in the majority of cases.

At the same time that this disease prevails, there prevails also
another disease, endemic to this city in the summer and fall; cases
of each are seen in juxta-position, and'each presents its distinctive
peculiarities. Whatever points of assimilation there may be be-
l ween them, however the digestive functions may be disturbed in
each, there is no identity.

I know that some physicians, when an epidemic prevails, consider
that all diseases then occurring are modified by its influence. This
is true to a partial extent. But the effect is the development of the
disease itself on the least exciting cause, and not the development
of a hybrid compound. Now during the last season, I treated a
great number of climate fever, intermittent and remittent. There
was not the slightest difficulty in deciding upon their character and
treatment, after sufficient time had elapsed to show their periodicity.
But, when I was first called to a patient, and was asked "have I got
the dengue ?" my answer invariably was, "I will tell you in a day or
two. ' If the eruption did not appear, I did not consider it a case of
dengue. On this point the epidemic showed some variation of
symptoms from what it did in Charleston, for I infer from Dr.
Dickson's recent article on dengue, that the eruption was deficient
in a great number of cases there, 1 say positively that I met with
no case which I thought entitled to be considered dengue, in which
the eruption did not appear at some period. 1 am also inclined to
think that this disease appeared in a more simple form here than
elsewhere, from the fact that Dr. Campbell, of Augusta, styles it a
"truly Protean epidemic," as seen in that city. Beyond that variety
of symptoms which any disease shows in different individuals, I
could not apply this term to the epidemic here. On the contrary,
it was marked and distinct. Of course some were affected more
violently than others, presenting variety as to the intensity of pain,
and as to the affection of the digestive functions. Many persons
who had the disease here, did not go to bed. There are two cir-

14 Arnold: Dengue, or Break-hour Eever. [Not.

cumstances about this disease, as it has shown itself in our City,
which merit consideration.

First. It has shown itself here to be a city disease, as yellow
fever is. It was extensively epidemic here in 1826, and 1:828, and
1850. Almost every body in the city had it. Speaking of the
epidemic of 1828, Dr. Waring gives us the following distinct testi-
mony :

"I have said that dengue was essentially the break-bone which we
had experienced in 1826, and also in 1827. The analogy was so
sti iking, that 1 do not believe we should have called it by another
name, if it had not appeared in some other Southern cities at the
same time. The points of resemblance were the universality of
both diseases, the same gradual progress, by which the entire popu-
lation became involved, excrutiating pain of the limbs and loins.
the same species of cutaneous inflammation, singular violence and
short duration both, their common characteristic of forming but one
paroxysm, red injection of the vessels of the conjunctiva, uniform
recovery."

In 1827 our city was visited epidemically by yellow fever, its last
epidemic visitation. Further on, he says, referring to the years
1826. 1827 and 1828, "As regards yellow ivxev. break-bone and
dengue, the remote cause confined itself to the boundaries of the
city proper."

This has not been the case with scarlet fever and nieasels. They
have prevailed extensively on plantations. Now, although dengue
prevailed for a series of three years, viz : 1826, 1827 and 1828, in
the city proper, and, during two of those years, was very general,
we here have distinct testimony as to its being confined to those
limits. The same occurred in 1850. For aught I know, a few iso-
lated cases may have got into the country surrounding us. but the
disease certainly never became epidemic there.

Dr. James P. Screven, of this city, who was a practitioner in
1826 and 1828, in a conversation with me. mentioned the fact of
the confinement of this disease, at that time, to the limits of the
city, as a peculiarity in it. He thus corroborated the observation
of Dr. Waring. Dr. S. is one of the most extensive planters on
the Savannah river, and he stated that he was not aware of the oc-
currence of a single case on any of his plantations, during the past
year.

Second. This disease is undoubtedly affected by frost. The
diminution of cases after a frost last fall was as marked as the

1853.] Arnold: Dengue, or Break-bone Fever. 15

diminution of cases in our endemic climate fever usually is. Per-
sons who had the seeds of disease latent at the time, became affect-
ed afterwards. About the beginning of November cases became
quite rare, but a case was occasionally met with. On the 18th No-
vember I saw the last case of the season, as far as regards my expe-
rience. It occurred in an infant eight months old, who had been
absent during the summer, but had returned about the end of Octo-
ber.

How did this disease originate ? When a definite answer is re-
turned, as to the origin of small-pox, scarlet fever, measles, or hoop-
ing-cough, I shall expect one to this question.

I have not aimed at giving any particularly graphic description of
this disease, as it appeared, here last summer. I have been struck,
however, with the fact of its former epidemic prevalence here, in
1826 and 1828. A careful perusal of Dr. Waring's admirable arti-
cle has convinced me of the identity of these former epidemics with
the one of 1850. Both Dr. Waring and Dr. Daniell, of this city.
as quoted by Dr. Dickson, contended for the identity of the break-
bone of 1826 and the dengue of 1828. As eye witnesses, and as
baying given their testimony many years ago, their evidence cannot
be set aside to suit any theory. Dr. Dickson, in his first article on
dengue, dwells with emphasis on the testimony of Dr. Stedman, as
to its starting point, in this hemisphere, being at St. Thomas's, in
1827. How it happened to come to Savannah, in 1826, will, I sup-
pose, be solved at the Greek calends. Dr. Dickson acknowledges
the identity of the epidemic of 1850 with that of 1828 ; and Dr.
Waring and Dr. Daniell, the identity of that of 1828 with that of
1826. Here is the chain of evidence complete. It certainly did
not come to Savannah from St. Thomas's, in 1826. The truth is,
that there is a singular propensity in communities to blame other
communities for the origin of epidemic diseases. If I mistake not.
in Charleston the scape-goat for yellow fever is Havana. Now, on
the 1st day of December, 1849, I treated a decided case of yellow
fever, terminating in black vomit and death, which had been con-
tracted in Charleston by a foreigner, who had stopped there two
weeks on his way hither. I was called in on a Saturday. The man
had arrived the previous night, on one of the Charleston boats. On
Sunday he threw up black vomit, and on Monday he died — and
there was the end of it and him. Now, had this case occurred early
in the season, and had others occurred after it, the contagionists
would have blamed Charleston for all such cases. I should not ;
because in 1839 I saw two cases of yellow fever, ending in black
romit, occurring under circumstances which ought to have favored
its spreading. Yellow fever prevailed epidemically in that year, in
Charleston and in Augusta. At the latter end of August, of that

16 Arnold: Dengue, or Break-bom' Fever. [Nov.

year, a man who had just left Charleston entered the hospital, the
wards of which were then filled with cases of bilious remittent
fever. He died with black vomit. About ten 'lavs afterwards
another man entered, who had just left Augusta. He died with
black vomit.

If these patients did not bring the disease hither with them it was
sporadic here ; if they did, it certainly foiled to propagate itself,
under circumstances highly favorable to such propagation — but not
a single patient contracted the disease. Now, had there existed an
epidemic tendency to this disease, and had it broken out short I \
after the occurrence of these two cases, they would have been con-
sidered irrefragable evidence of its contagiousness. That a peculiar
disease, like yellow fever, failed to propagate itself, when introduced
into the wards of a fever hospital, in the very season of the year
when climate fevers are endemic, is surely entitled to be considered
more than negative evidence on the subject of its contagiousness.

My first cases of dengue or breakbone occurred the 29th of Au-
gust. This disease had been prevailing epidemically in Charleston.
for more than a month. There is a daily communication between
this city and Charleston by steamboats, going from wharf to wharf.
Here certainly was a means of communicating contagious matti i .
But no one in our city made any movement towards quarantining
Charleston.

Neither of those cases had had any communication, direct or in-
direct, with Charleston. The disease was not then known to exist
here. There was no centre in our city from which to trace their
radiation. They were owing, according to my belief, to an epidemic
influence. Persons say that means nothing. 1 differ from them.
Those words express a fact, however unable we may be to solve the
ultimate cause of that fact.

The dengue last year was really epidemic. Persons from abroad,
who came within our limits, were seized with it, without ever having
been near any body sick with it.. 1 detailed, in my article alluded
to before, the case of W. D., Esq., and my own, which occurred in
the fall of 1848. Each was the only case in our respective families.
No precaution was taken for isolation, in either case; yet no other
individual of our families contracted the disease. Is such a fad of
no importance, in deciding upon the contagiousness or non-conta-
giousness of this disease? I confess that I cannot account for the
origin of the first cases, on the theory of contagion ; nor did the
disease spread in a manner to induce such a belief. It did not, to
be sure, burst out at once, in every part of the city ; but it did
break out at various points, within a very few days of the first
cases, and, by the middle of September, it had visited every portion
of it,

Fortunately, this disease, which seems to prevail so generally
when it does appear amongst us, is one of no fatality. Tedious
convalescence, and in some few instances, one of which is now under
my care, chronic arthritic rheumatism are its only effects.